Prior to applying a negative pressure dressing, a wound (or other opened-flesh medical condition) is typically cleansed and debrided. Therapeutic treatment of a wound often also involves packing the wound-bed with sterile material. Such material may include gauze, foam or other suitable fluid-absorbing/transferring materials. Application of negative pressure to the packed wound-bed promotes wound-healing.
The term “negative pressure” as used herein refers to lower than ambient air pressure. Widespread clinical experience sets the range of values of negative pressure utilized in wound treatment. Negative pressure treatment (hereinafter referred to as NPT) of wounds has been practiced for more than a decade.
The clinically demonstrated promotion of wound-healing that may be achieved through NPT requires successful practitioner-preparation of the wound and surrounding site. Conventionally, preparation of a wound for NPT complicates the wound-packing procedure for both practitioner and patient.
In conventional preparation for NPT, a practitioner needs to pause the wound-packing procedure at an intermediate stage, with the base of the prepared wound covered but with the wound-bed only partly packed. An appropriately sized wound-fluid NPT drain is introduced into the partly packed wound-bed.
A typical wound-fluid NPT drain may include a hollow tube-like structure featuring transversely perforated walls. Such perforation provides access to the drain's hollow center, which may or may not be capped on one end. A tube for application of negative pressure and for drainage of exuded wound-fluid typically attaches to, or is integrally continuous with, the other end of the drain. This vacuum/drainage tube exits the wound-bed and extends beyond it.
The NPT drain is associated in situ with the initial packing material within the wound-bed. More specifically, the NPT drain is typically placed upon the gauze or inserted within the foam. Location and orientation of the drain within the confines of the wound-bed may affect the efficiency of drainage and the quality of wound-closing.
To maintain the NPT drain's placement and orientation, anchorage of the exiting vacuum/drainage tube may be required. The exiting tube is preferably anchored in close proximity to the wound. Typically, the vacuum/drainage tube is taped to the patient's perilesional and/or other wound-proximal skin.
Conventionally, maintenance of NPT drain-and-tube emplacement and orientation may complicate the remaining stages of the wound-packing procedure. A practitioner laying the remaining packing material into the wound-bed may need to exercise caution to accommodate the presence of the NPT drain-and-tube. Even with the vacuum/drainage tube skin-anchored close to the wound, manipulations involved in completing the wound-packing procedure may deleteriously shift the NPT drain-and-tube.
The fully-packed wound-bed, with the emplaced NPT drain and the exiting vacuum/drainage tube, is completely draped with a flexible covering. The draping material closely adheres to sufficient skin area surrounding the wound-site to produce a perimeter seal that remains airtight under NPT conditions of negative wound-bed air pressure.
Particular wound-sites featuring high degrees of local moistness and/or contouring, may present challenges to producing effective airtight perimeter sealing. Practitioner-preparation of the wound for NPT requires smoothly adhering the surface-conforming draping material to the wider site's contours, with minimal disturbance of the packing, drain or tube. Such a procedure may be difficult and time-consuming.
The draping must allow for egress of the vacuum/drainage tube from the vicinity of the wound-site. The tube-egress may be sealed at the edge of the draping material by taping both the draping material and the vacuum/drainage tube at the site of tube-egress to the patient's skin. Such additional taping may be painful to the patient.
The end of the vacuum/drainage tube may be configured to connect to tubing leading to a suitable NPT vacuum controller. Wound-fluid exudate is drained from the sealed, packed wound-bed through the tubing, to a collection/disposal vessel associated with the vacuum controller. Prior to its disposal, collected exudate may be monitored as to volume, volume per time, fluid and cellular composition, bacterial count and/or other parameter(s) of clinical interest.
The therapeutic advantages of NPT have been clinically demonstrated for a broad variety of wound types, including but not limited to burns, lacerations, bed sores, etc. Improved patient-outcomes—including acceleration of wound-healing, decrease of infection and of necrosis, and enhancement of wound-closure quality—have been repeatedly noted in clinical studies.
Attainment of the clinical benefits of NPT depends upon successful practitioner-preparation of the wound-bed, of the surrounding perilesional area, and of the wider site. The number and intricacy of conventional NPT-required manipulations may make it difficult for a lone practitioner to efficiently carry out the procedure (while practical and institutional constraints may limit the number of practitioners and aides available); may lead to the need to repeat part or all of the procedure so as to correct earlier errors and/or later shifting of components; may contribute to incomplete success of the procedure, depriving the patient of the full benefit of NPT.
In the treatment of a typical wound, the above steps may be repeatedly applied over several courses of NPT. (As used herein, the term “course of NPT” refers to all NPT sessions performed on a given wound with a given NPT dressing in place; the term “NPT session” refers to any specific length of time over which the NPT vacuum controller applies continuous and/or intermittent negative pressure.) Each course of NPT may include, at the outset, cleansing and assessment of the progressively smaller wound-bed, followed by application of the dressing. Inherent painfulness may attend repeated manipulations of the wound-bed and surrounding wound-site, compounding the difficulties and complications involved in preparation of a wound for NPT by conventional apparatus and methods.
It would be desirable, therefore, to provide apparatus and methods for streamlining and simplifying preparation of a wound-site for NPT.